As commander in chief of the armed forces, the President of Uganda mandated the Uganda Peoples

Defense Force UPDF's AIDS Control Program to oversee and manage prevention, care, and treatment

programs throughout the forces and their families. PMTCT services have been implemented in four out of

eight Army units over the past two years, and processes are underway to raise awareness and increase

access of pregnant women to these programs. In FY08 Midwives and nurses will be trained in 3 of the

PMTCT centers. A good number of medical workers have completed military training and will be deployed

to the various health centers. It is hoped that with additional medical workers being available in the army,

PMTCT services will be expanded to cover all the centers.

UPDF plans to strengthen its current PMCT activities and expand the services to 4 other sites while

emphasizing the linkage with clinical services. A total of 1200 mothers attending ANC were counseled and

tested in the period August 2006 to July 2007 out of which 200 were positive and 80 were referred

treatment at PMTCT Centers. PMTCT will also be used as an entry point into ART and HIVAIDS Care

services for families of UPDF staff and an avenue to identify discordant couples, as well as Prevention With

Positives (PWP) interventions. In FY08, UPDF targets to reach 300 pregnant HIV positive mothers through

Counseling and Testing; and provide them with effective ARV prophylaxis for PMTCT. Currently UPDF does

not provide services for Early Infant Diagnosis (EID) for the HIV exposed infants. Efforts will be made

provide this service in collaboration other PEPFAR sites currently offering this service.

Along side this activity, UPDF will strengthen infant feeding counseling services to support all HIV positive

mothers to exclusively breast feed up to six months of age.

The UPDF is Uganda's national Army. As a mobile population of primarily young men, they are considered

a high-risk population. Uganda initiated programs for high-risk groups in the early phases of the epidemic

and continues to promote excellent principles of nondiscrimination in its National Strategic Framework.

Starting in 1987, the Minister of Defense developed an HIV/AIDS program after finding that a number of

servicemen tested HIV positive. As commander in chief of the armed forces, the President mandated the

UPDF's AIDS Control Program to oversee and manage prevention, care and treatment programs through

out the forces. Although the exact HIV prevalence rates from the military are unknown, it is estimated that

approximately 10,000 military are living with HIV with up to an additional 10,000 HIV infected family

members. The UPDF HIV/AIDS Control program is comprehensive and covers the critical elements of

prevention, such as counseling and testing, peer education, condom distribution, and PMTCT; HIV care,

such as palliative care services and ARV services; and human and infrastructure capacity building Uganda

initiated programs for high-risk groups in the early phases of the epidemic that have a basis of excellent

principles of nondiscrimination and span the spectrum of Abstinence, Be Faithful, and use of Condoms.

The UPDF supports this National Framework, and has utilized post test clubs as one of the cornerstones for

prevention strategies. Formed mainly from persons who have tested positive, the clubs are open to all

military personnel, their families, and the people from the surrounding community who has tested for HIV.

The clubs are also seen as an important link for care and treatment services and for follow-up for

psychosocial support. Another common practice which has been highly effective for the commanders to

reach through to the troops, has been the use of military parades, to pass on information using open

discussions with disclosure by the PTC members. Current activities are training of trainers to have ‘focal

points' of peer educators within these PTCs, expanding the peer education program to include an emphasis

on gender issues, family planning, challenging male norms, and addressing stigma and discrimination and

ARV adherence. Distribution of condoms from the Ministry of Health has been extended to 12 centers,

which will continue to be a focus of prevention activities.

For 08, the cadre of peer educators within the PTCs associated with each of the 13 VCTs will be expanded,

with a concomitant increase in the HIV Prevention activities of awareness, abstinence and being faithful,

and delaying of sexual debut, and pre and post test counseling. Encouraging disclosure that will increase

the number of spouses of HIV positive soldiers for testing, Training for these PTC counselors will also

include prevention for positives and better inclusion of family members with testing, counseling, and clinical

care. Extending the reach of these PTC counselors via mobile services is also planned. Specific

individuals will be identified within each military unit as a distribution point for peer education and condom

distribution to increase distribution beyond the 12 fixed sites.

The UPDF is Uganda's national Army. As a mobile population of primarily young men, they are considered

a high-risk population. Uganda initiated programs for high-risk groups in the early phases of the epidemic

and continues to promote excellent principles of nondiscrimination in its National Strategic Framework.

Starting in 1987, the Minister of Defense developed an HIV/AIDS program after finding that a number of

servicemen tested HIV positive. As commander in chief of the armed forces, the President mandated the

UPDF's AIDS Control Program to oversee and manage prevention, care and treatment programs through

out the forces. Although the exact HIV prevalence rates from the military are unknown, it is estimated that

approximately 10,000 military are living with HIV with up to an additional 10,000 HIV infected family

members. The UPDF HIV/AIDS Control program is comprehensive and covers the critical elements of

prevention, such as counseling and testing, peer education, condom distribution, and PMTCT; HIV care,

such as palliative care services and ARV services; and human and infrastructure capacity building. More

recently provision of ART has been initiated on a larger scale, in 8 military sites, with drug provision via

JCRC (COP 07:$250K for ARVs, $250K for services).

Currently the UPDF is initiating new activities in the area of Injection Safety. The UPDF medical staff

provides services to many HIV infected clients throughout their medical units, as well as patients with other

blood and respiratory borne diseases. There is therefore potential for patient-health worker inter-

transmission of HIV and other infections in the clinical settings. The UPDF is strengthening its infection

control prevention strategies in the health units and hospitals to address risk factors and implement control

measures. Safe injection practices and PEP are being promoted consistent with the existing national

guidelines, in collaboration with the USG program being implemented by John Snow, Inc. (JSI) Rapid

Interventions to Decrease Unsafe Injections and Preventing the Medical Transmission of HIV.

For FY 08 we plan to continue strengthening the initiated injection safety mechanisms

The UPDF is Uganda's national Army. As a mobile population of primarily young men, they are considered

a high-risk population. Uganda initiated programs for high-risk groups in the early phases of the epidemic

and continues to promote excellent principles of nondiscrimination in its National Strategic Framework.

Starting in 1987, the Minister of Defense developed an HIV/AIDS program after finding that a number of

servicemen tested HIV positive. As commander in chief of the armed forces, the President mandated the

UPDF's AIDS Control Program to oversee and manage prevention, care and treatment programs through

out the forces. Although the exact HIV prevalence rates from the military are unknown, it is estimated that

approximately 10,000 military are living with HIV with up to an additional 10,000 HIV infected family

members. The UPDF HIV/AIDS Control program is comprehensive and covers the critical elements of

prevention, such as counseling and testing, peer education, condom distribution, and PMTCT; HIV care,

such as palliative care services and ARV services; and human and infrastructure capacity building Uganda

initiated programs for high-risk groups in the early phases of the epidemic that have a basis of excellent

principles of nondiscrimination and span the spectrum of Abstinence, Be Faithful, and use of Condoms.

The UPDF supports this National Framework, and has utilized post test clubs as one of the cornerstones for

prevention strategies. Formed mainly from persons who have tested positive, the clubs are open to all

military personnel, their families, and the people from the surrounding community who has tested for HIV.

The clubs are also seen as an important link for care and treatment services and for follow-up for

psychosocial support. Another common practice which has been highly effective for the commanders to

reach through to the troops, has been the use of military parades, to pass on information using open

discussions with disclosure by the PTC members. Current activities are training of trainers to have ‘focal

points' of peer educators within these PTCs, expanding the peer education program to include an emphasis

on gender issues, family planning, challenging male norms, and addressing stigma and discrimination and

ARV adherence. Distribution of condoms from the Ministry of Health has been extended to 12 centers,

which will continue to be a focus of prevention activities.

For 08, the cadre of peer educators within the PTCs associated with each of the 13 VCTs will be expanded,

with a concomitant increase in the HIV Prevention activities of awareness, abstinence and being faithful,

and delaying of sexual debut, and pre and post test counseling. Encouraging disclosure that will increase

the number of spouses of HIV positive soldiers for testing, Training for these PTC counselors will also

include prevention for positives and better inclusion of family members with testing, counseling, and clinical

care. Extending the reach of these PTC counselors via mobile services is also planned. Specific

individuals will be identified within each military unit as a distribution point for peer education and condom

distribution to increase distribution beyond the 12 fixed sites.

The UPDF is Uganda's national Army. As a mobile population of primarily young men, they are considered

a high-risk population. Uganda initiated programs for high-risk groups in the early phases of the epidemic

and continues to promote excellent principles of nondiscrimination in its National Strategic Framework.

Starting in 1987, the Minister of Defense developed an HIV/AIDS program after finding that a number of

servicemen tested HIV positive. As commander in chief of the armed forces, the President mandated the

UPDF's AIDS Control Program to oversee and manage prevention, care and treatment programs through

out the forces. Although the exact HIV prevalence rates from the military are unknown, it is estimated that

approximately 10,000 military are living with HIV with up to an additional 10,000 HIV infected family

members. The UPDF HIV/AIDS Control program is comprehensive and covers the critical elements of

prevention, such as counseling and testing, peer education, condom distribution, and PMTCT; HIV care,

such as palliative care services and ARV services; and human and infrastructure capacity building. More

recently provision of ART has been initiated on a larger scale, in 8 military sites, with drug provision via

JCRC (COP 07:$250K for ARVs, $250K for services).

The Ugandan military continues to have challenges in providing adequate clinical care services to the

estimated 15,000 to 20,000 HIV infected personnel and family members. This is due to a lack of trained

clinical staff, an automated medical information system, and inadequate laboratory diagnostics for OIs and

co-infections. These inadequacies are being systematically addressed via the support from the USG,

initially in the Kampala based Bombo military hospital, and Mbuya military Hospital, with expansion to

military medical facilities in Nakasongola and Wakiso. Drugs for OI prophylaxis and treatment are being

procured for these 3 sites. Particular attention is paid to widows and OVCs that are eligible for services. A

course has been developed for nurses and clinical officers through the Infectious Diseases Institute,

Kampala and for the past 2 years this training has been used to ramp up care in HIV clinical management,

to include addressing military specific issues.

Currently these activities (diagnosis and treatment of OIs, drug procurement, training, lab services),

continue and expand beyond the 2 major clinical sites in Kampala and 2 outside Kampala sites to all 8 sites

within the military health network providing ARV access. STI diagnostics and therapeutics and training for

HCWs is being initiated. A new and extremely important expansion, given the recent compelling data

confirming efficacy, plans are underway to provide access to the Basic Health Care Package (impregnated

mosquito nets; safe water vessel; co-trimoxazole) to the UPDF HIV positive personnel and family members

plus piloting the use of the BHC package in deployment/field scenarios

The UPDF is Uganda's national Army. As a mobile population of primarily young men, they are considered

a high-risk population. Uganda initiated programs for high-risk groups in the early phases of the epidemic

and continues to promote excellent principles of nondiscrimination in its National Strategic Framework.

Starting in 1987, the Minister of Defense developed an HIV/AIDS program after finding that a number of

servicemen tested HIV positive. As commander in chief of the armed forces, the President mandated the

UPDF's AIDS Control Program to oversee and manage prevention, care and treatment programs through

out the forces. Although the exact HIV prevalence rates from the military are unknown, it is estimated that

approximately 10,000 military are living with HIV with up to an additional 10,000 HIV infected family

members. The UPDF HIV/AIDS Control program is comprehensive and covers the critical elements of

prevention, such as counseling and testing, peer education, condom distribution, and PMTCT; HIV care,

such as palliative care services and ARV services; and human and infrastructure capacity building.

Co-infection with TB is a substantial challenge for the medical management of HIV infected patients in the

UPDF. The UPDF hopes to further strengthen the control and management of TB in the military. Activities

for the year 2008 will include: Introduce and promote DOTS in TB treatment, Counseling and testing of

suspected TB cases, Strengthen and referrals for TB treatment, Strengthen and coordinate with the national

health system in the roll out of the TB/HIV policy. Mobilize and bring the army leadership and commanders

in the management of TB to improve on adherence to therapy. Ensure adequate and constant supply of anti

TB drugs and reagents. Undertake a study on the prevalence of MDR TB in the military and factors that

may be funning it.

The UPDF is Uganda's national Army. As a mobile population of primarily young men, they are considered

a high-risk population. Uganda initiated programs for high-risk groups in the early phases of the epidemic

and continues to promote excellent principles of nondiscrimination in its National Strategic Framework.

Starting in 1987, the Minister of Defense developed an HIV/AIDS program after finding that a number of

servicemen tested HIV positive. As commander in chief of the armed forces, the President mandated the

UPDF's AIDS Control Program to oversee and manage prevention, care and treatment programs through

out the forces. Although the exact HIV prevalence rates from the military are unknown, it is estimated that

approximately 10,000 military are living with HIV with up to an additional 10,000 HIV infected family

members. The UPDF HIV/AIDS Control program is comprehensive and covers the critical elements of

prevention, such as counseling and testing, peer education, condom distribution, and PMTCT; HIV care,

such as palliative care services and ARV services; and human and infrastructure capacity building

AIDS and war continue to be the topmost causes of death among UPDF personnel and their families. As a

result, the Uganda Peoples Defense Forces has got a large burden of orphans that are either infected by

HIV or vulnerable to being infected. Most of these orphans are enrolled within the army schools. Little

attention has to-date been given to this vulnerable group. Currently the UPDF is initiating support activities

for the OVCs as a school based program through health education about Abstinence, strengthening

counseling and care services in the schools, and fighting stigma against those infected, especially those on

ART. In achieving this, the teachers are specifically targeted, sensitized and empowered to enable them

incorporate the activities in their routine duties. PHA's households are being trageted targeted to ensure

that the OVC are linked to OVC services as well as care and treatment.

For FY08, school based programs will be scaled up and will be expanded to include training young people

in life skills, reproductive health skills and developing appropriate tools for training. OVC that are out of

schools will be identified and equipped with skills to empower them cope up with the challenges of

HIV/AIDS.

The UPDF is Uganda's national Army. As a mobile population of primarily young men, they are considered

a high-risk population. Uganda initiated programs for high-risk groups in the early phases of the epidemic

and continues to promote excellent principles of nondiscrimination in its National Strategic Framework.

Starting in 1987, the Minister of Defense developed an HIV/AIDS program after finding that a number of

servicemen tested HIV positive. As commander in chief of the armed forces, the President mandated the

UPDF's AIDS Control Program to oversee and manage prevention, care and treatment programs through

out the forces. Although the exact HIV prevalence rates from the military are unknown, it is estimated that

approximately 10,000 military are living with HIV with up to an additional 10,000 HIV infected family

members. The UPDF HIV/AIDS Control program is comprehensive and covers the critical elements of

prevention, such as counseling and testing, peer education, condom distribution, and PMTCT; HIV care,

such as palliative care services and ARV services; and human and infrastructure capacity building. More

recently provision of ART has been initiated on a larger scale, in 8 military sites, with drug provision via

JCRC (COP 07:$250K for ARVs, $250K for services).

The USG is the primary supporter of HIV CT services within the armed forces. With support that began in

2003, the number of HIV CT service centers has grown from 0 to 13, based in the major military bases and

spread throughout the country. There has been a strong uptake of testing, which has in part been facilitated

by the awareness and counseling services of the Post Test Clubs. Over 8,000 persons were reached in

these centers in 2005. In 2006, along with supporting the on-going centers, the process of extending HIV

CT services into hospitals and clinics (RTC) began.

Currently there is continued support for the 13 established C & T centers, continuation of RCT, with a new

activity of adding mobile testing and counseling services. This allows reach of military personnel and their

family members that are not co-located with a military clinic and can be linked with other palliative care

services for these hard to reach populations. There is also focus on quality assurance.

For FY 08 we plan to continue with the support for the 13 established C & T centers and continuation of

RCT.

The UPDF is Uganda's national Army. As a mobile population of primarily young men, they are considered

a high-risk population. Uganda initiated programs for high-risk groups in the early phases of the epidemic

and continues to promote excellent principles of nondiscrimination in its National Strategic Framework.

Starting in 1987, the Minister of Defense developed an HIV/AIDS program after finding that a number of

servicemen tested HIV positive. As commander in chief of the armed forces, the President mandated the

UPDF's AIDS Control Program to oversee and manage prevention, care and treatment programs through

out the forces. Although the exact HIV prevalence rates from the military are unknown, it is estimated that

approximately 10,000 military are living with HIV with up to an additional 10,000 HIV infected family

members. The UPDF HIV/AIDS Control program is comprehensive and covers the critical elements of

prevention, such as counseling and testing, peer education, condom distribution, and PMTCT; HIV care,

such as palliative care services and ARV services; and human and infrastructure capacity building. More

recently provision of ART has been initiated on a larger scale, in 8 military sites, with drug provision via

JCRC (COP 07:$250K for ARVs, $250K for services).

Beyond the estimated 20,000 military personnel and family members that are HIV infected, military medical

clinics are also available to civilians, and in some locations are utilized by the surrounding civilian

communities. Thus the demand to provide quality ARV services is continually growing. In mid-2004, two

army hospitals were accredited to deliver ART, starting with drugs provided by the Global Fund. This has

been expanded through the PEPFAR to 8 sites serving 1800 adults, spouses, and children. ARV services

have been strengthened through training of health care providers, via the Infectious Diseases Institute (IDI)

based in Kampala, and a partnership with San Diego DHAPP. A critical cornerstone of safe, effective ARV

treatment is high compliance. Military personnel have unique challenges and obstacles for medication

adherence, given barracks living, deployments, and the stigma associated with HIV/AIDS. A needs

assessment and pilot adherence program is being initiated to specifically address ARV compliance in the

military, and will be centered at Bombo Barracks and Mbuya Hospital.

Current plans are to support expansion of ARV services in training of UPDF personnel and modify and

extend the adherence protocol to the other 6 treatment sites. This program will also be evaluated, and clinic

procedures modified to include adherence practices as standard protocol. Additional training of physicians

(6) and nurses and clinical officers (25), through the IDI in Kampala and the DHAPP program (2) will also be

conducted. The IDI in collaboration with the UPDF have developed a 4 week (and 2 week respectively)

course aimed to ramp up skills in ARV use, recognition and management of OIs and PMTC. Monitoring of

clinical services with a medical information systems (MIS) to optimize clinical management will be initiated.

There will be more of an emphasis on integration of prevention care and treatment programs; and

increasing the availability of materials for client-provider interaction.

In FY 08 we plan to continue supporting the expansion of ARV services to cope with the increasing demand

in the UPDF

The UPDF is Uganda's national Army. As a mobile population of primarily young men, they are considered

a high-risk population. Uganda initiated programs for high-risk groups in the early phases of the epidemic

and continues to promote excellent principles of nondiscrimination in its National Strategic Framework.

Starting in 1987, the Minister of Defense developed an HIV/AIDS program after finding that a number of

servicemen tested HIV positive. As commander in chief of the armed forces, the President mandated the

UPDF's AIDS Control Program to oversee and manage prevention, care and treatment programs through

out the forces. Although the exact HIV prevalence rates from the military are unknown, it is estimated that

approximately 10,000 military are living with HIV with up to an additional 10,000 HIV infected family

members. The UPDF HIV/AIDS Control program is comprehensive and covers the critical elements of

prevention, such as counseling and testing, peer education, condom distribution, and PMTCT; HIV care,

such as palliative care services and ARV services; and human and infrastructure capacity building. More

recently provision of ART has been initiated on a larger scale, in 8 military sites, with drug provision via

JCRC (COP 07:$250K for ARVs, $250K for services).

Support is needed to accurately and completely capture PEPFAR targets from program activities in the field

and the necessary routine clinical data at the service point level. This effort will be coordinated through the

Uganda Country team S & I program/system. In FY05, the focus was on capacity building in terms of skills

and training, with the initial primary clinical sites of Bombo Barracks and Mbuya in Kampala. Collection of

accurate routine data has been a significant challenge, particularly at the service point level. There will be a

growing emphasis on systems in 06. Additionally, preparation for a large randomized behavioral

seroprevalence study of UPDF active duty personnel was accomplished; the seroprevalence survey will be

completed in COP 06 activities.

Current activities include modifying the pilot MIS structure and extending it to at least 3 additional clinical

sites. The seroprevalence survey is to be conducted during, with analysis, study summaries, and

modification and adoption of the protocols for ongoing surveillance as a primary activity in 07. A needs

assessment and pilot QA activities for ART centers will be initiated.

In FY 08 we plan to continue strengthening the information system in the UPDF.

The Department of Defense (DoD) supports the Uganda Peoples Defense Forces AIDS Control program by

providing funding, logistical and technical support. In FY 07 DoD hired one full time staff to coordinate the

program. From the MEEP Report a number areas were identified that need to be addressed to ensure

quality HIV/AIDS service delivery in the UPDF. One of the key areas identified was the shortage of staffing

in the medical unit. To this effect in FY Y08 DoD plans to hire a Medical Officer to provide Technical support

initially to be based at Bombo Military Hospital but with support to other sites in the HIV/ADS programming

and management. DoD also plans to hire a part time Administrative Assistant to be based at Bombo as well.